Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: A randomized, double-blind, controlled trial

Jie Yu*, Sudhir Raj Thout, Qiang Li, Maoyi Tian, Matti Marklund, Clare Arnott, Mark D. Huffman, Devarsetty Praveen, Claire Johnson, Liping Huang, Simone Pettigrew, Bruce Neal, Jason H.Y. Wu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensive patients. Objectives: Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensive patients. Methods: We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided. Results: A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly. Conclusion: The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensive patients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659.

Original languageEnglish (US)
Pages (from-to)185-193
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Volume114
Issue number1
DOIs
StatePublished - Jul 1 2021
Externally publishedYes

Keywords

  • India
  • blood pressure
  • potassium
  • salt substitute
  • sodium

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Fingerprint

Dive into the research topics of 'Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: A randomized, double-blind, controlled trial'. Together they form a unique fingerprint.

Cite this